Cost Evaluation of COVID-19 Remote Home Monitoring Services' Patients in England during Wave 2 from October 2020-April 2021

Objectives: During the COVID-19 pandemic, the NHS delivered a community-based remote home monitoring service for COVID-19 patients. The service came in two models characterised based on the referral method: home-based care to ensure the right people were admitted at hospital at the right time (named COVID Oximetry @ home (CO@h)) and facilitation of patients' transition when discharged home (named Covid-19 Virtual Ward (CVW)). Patients were provided with pulse oximeters and asked to regularly record and submit oxygen levels and other symptoms to a team of administrators and clinicians via digital means (tech-enable and analogue mode) and/or over the phone (analogue). Our aim was to evaluate the costs of implementing these services in England during wave 2 of the pandemic (October 2020-April 2021). Method(s): We used a top-down approach to describe the costs of setting-up and running the service. 26 sites reported the number of patients and staff members involved in the service, and other used resources. Descriptive statistics and multivariate regression analysis were used appropriately. Result(s): The mean cost per patient monitored was lower in the CO@h service compared to the CVW (527.5 vs. 599.1). The corresponding cost was lower for sites using tech-enabled and analogue data submission mode compared to sites using analogue-only mode for both CO@h (515 vs. 561) and CVW (584 vs. 612) services. The number of patients enrolled in the service and the service type significantly affected the mean cost per patient (b=0.62, p= 0.001;b=-457.99, p=0.05 correspondingly). Conclusion(s): Our analysis offers a model for future research since it covers sites of various sizes and raises questions about different practices within the overall remote monitoring services.Copyright © 2023

Procedure Based Telehealth Utilization in General Surgery

Introduction: After COVID-19, telehealth (TH) capabilities expanded relaying patient satisfaction, time savings, and efficient access to care. We hypothesize standardized TH scheduling processes improves TH utilization without increasing adverse events (AE). Method(s): The Telehealth Utilization Quality Improvement Initiative was conducted from 8/2021-1/2022 in the general surgery clinic. 50 visits pre-implementation and 70 visits post-implementation were audited over the study period. Stakeholders were engaged including faculty, clinic coordinators, and administrative staff to identify current workflows and potential interventions, targeting outpatient elective procedures. Process mapping outlined current TH scheduling workflows. Outcomes such as percent TH scheduled in clinic, in addition to cost, and adverse patient events were collected post-implementation. Result(s): Preliminary data revealed 50 patients who underwent elective outpatient surgeries, all appropriate for TH postoperative follow-up visits. Overall, the pre-implementation TH scheduling rate was 32%. TH was schedule dafter surgery in the preintervention group. The intervention required TH postoperative appointments to be scheduled in clinic at the time of surgery scheduling with TH being the default postsurgical appointment for a standardized list of eligible procedures. After implementation, 95% of patients undergoing elective, outpatient general surgery procedures were scheduled for a TH visit with 83% of patients completing their follow up via TH.This resulted in increased revenue of $30,431 in billable visits due to increased clinic visit availability. No AE were seen. Conclusion(s): Standardizing TH scheduling based on procedure improves the utilization of TH in outpatient, elective general surgery procedures resulting in improved clinic efficiency, increased revenue, and no AE.

Attitude and Practices of self-medication among the students of Sialkot Medical College, Sialkot

Background: During covid-19 period not only general public was victim of anxiety besides all medical professional also face anxiety and change their Information seeking behaviour according their personality. Curiosity is in human nature with the easy access to internet the new horizon to information has been opened. People searching trends have shown that they are interested in health risk to health treatment for their health related problems. Aim(s): In this study examined the influences of anxiety (ISA) and Personality traits (PT) on health information seeking behaviour (HISB) among the Doctor, paraprofessional and final year medical students who are frontline worker during pandemic situation. Methodology: The study adopted survey method with non-probability convenience sampling to collect statistical. Questionnaires werefiled from 313 participants by utilizing convenient sampling and analyzing the data through SPSS. Result(s): The result showed that significant relation between personality traits, information seeking anxiety and health information seeking behaviour. In medical library user PT has significant impact on HISB (p<.05), (AVG_PT=.002) and ISA has impact on HISB but it is not significant in medical professional (beta -.070) value shows ISA has negative impact on HISB. Practical implication: This study will be beneficial for information professionals, health care workers, policy makers and administrators to access of information resources in hybrid format. Conclusion(s): Medical professional's plays an important role in our society. They work hard and served the nation during pandemic situation. Anxiety is natural phenomena to every person. So medical professional also feel anxietybut the medical profession demands its professionals to stay cool, calm and free of anxiety by having analytical and cognitive skills, in order to fulfill the needs of their profession. This research helps to understand that ISA has no significant impact on HISB while PT has significant impact on HISB.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Primary care network (PCN) based 'type 2 diabetes optimisation clinics' run by primary care clinicians are a cost effective and efficient way of improving treatment targets for patients with poorly controlled diabetes, despite the constraints of the Covid-19 pandemic

Background: Approximately 10% of people living with type 2 diabetes in Waltham Forest (WF) who are treated with oral hypoglycaemic agents (OHA) alone and not under specialist care have an HbA1c > 75mmol/mol. No optimisation clinic exists at PCN level in WF, despite maximum capacity reached in specialist community and secondary care clinics. Aim(s): To establish a remote PCN based optimisation clinic during the Covid-19 pandemic, using motivational and patient empowerment interviewing techniques. Improvement in HbA1c, blood pressure and lipid profile underpinned the study. The 'behaviour change model' was also used to assess patient engagement. Method(s): We identified and consulted with 43 patients using an extended consultation of 25 min. Engagement and recall after 3 months were facilitated by a dedicated administrator and optimal care was ensured via monthly remote consultant input. Result(s): 38 patients were optimised with oral hypoglycaemic agents (OHA) alone and completed the pilot. 31/38 patients had an HbA1c reduction of more than 11mmol/ mol, with a significant overall median reduction across the whole cohort (pre 88mmol/mol vs 70mmol/mol, p < 0.0001). There was also a significant median reduction in triglyceride level (pre 1.56mmol/l vs 1.20mmol/l, p = 0.0247). In terms of behaviour change, all but one patient improved their behaviour towards their diabetes significantly. The approximate cost of the pilot per patient was 263 (excluding medication). Conclusion(s): A PCN based optimisation clinic using active recall is a cost effective and efficient method for significantly improving glycaemic control in people living with type 2 diabetes.

Perceptions of telemedicine in specialist outpatient services

Introduction/Aim: COVID-19 has fast-tracked changes to healthcare delivery, including the introduction of a broad range of telehealth services. Work is needed to assess the ongoing suitability of telemedicine for the post-pandemic era. We sought to explore perceptions of telemedicine amongst patients and providers (clinicians and health administrators) who had appointments in cardiology, respiratory, neurology, rheumatology and gastroenterology services in hospital specialist outpatient clinics in Sydney Local Health District. Method(s): Semi-structured interviews explored perceptions of consultations undertaken virtually compared to in-person, seeking perspectives on the benefits, limitations and risks of outpatient telemedicine consultations. The 37 participants comprised 16 patients, 14 specialists, 3 Clinical Nurse Consultants and 4 administrators. Result(s): Patients indicated satisfaction with telemedicine consultations, especially during the pandemic. They valued saving on travel time and costs, and being able to access care from their homes, thereby minimising risk of COVID exposure. The chief disadvantage perceived by patients was inability to receive a physical examination. They noted greater challenges for people with hearing and visual impairments, limited digital skills and/or computer access. Providers' perceptions were more ambivalent. Although telehealth was understood to help meet demands during the pandemic, mis- and under-diagnoses were considered major concerns arising from the inability to perform physical examination. Most regarded telemedicine as an effective tool for review appointments but mentioned an associated increased workload. All participants mentioned the need for relevant education and training, better integration of telemedicine platforms into existing infrastructure and the need for a hybrid model of care. Conclusion(s): Telemedicine played a unique role in meeting patients' needs during the pandemic and its convenience was valued by patients. Clinicians expressed concerns about missed diagnoses, uncertain clinical outcomes, lack of administrative and technological infrastructure. The ultimate test of telemedicine will be its impact on clinical outcomes versus longstanding models of in person care.

Co-designing an intervention to support safe medicines self-management for older people living with frailty and polypharmacy

Introduction: Older people face numerous challenges and safety risks when managing multiple medicines. They are required to cope with complex and changing regimens and co-ordinate input from multiple healthcare professionals. If not well managed, medicines can cause harm, and older people are more susceptible to errors. Some older people can devise and implement strategies to manage their medicines, e.g. creating checklists, ensuring timely supplies, solving problems, and seeking help (1). However, no interventions address the multiple tasks polypharmacy patients must perform to safely manage their regimens. Aim(s): To develop an intervention to support medicines self-management for older people living with frailty and polypharmacy using experience-based co-design (EBCD) (2). Method(s): Following video or audio-recorded qualitative interviews with 32 older people taking 5 or more medicines, a 'trigger film' of patients' medicines management experiences was produced and used during EBCD to facilitate priority setting. Separate meetings were held (1) with 16 staff (2 GPs, 4 GP practice administrators, 4 GP practice pharmacists, 1 practice lead, 2 senior nurses, 2 pharmacy technicians, 1 community pharmacist) and (2) with 13 patients and 2 family members, followed by a joint meeting with 8 older people and 9 staff where a shared set of three priorities was agreed. Two subsequent co-design workshops with 6 patients, 2 family members and 7 staff developed three candidate interventions. Workshop 1 explored key themes from the trigger film to develop solutions. Workshop 2 reviewed solutions and further developed design ideas. Intervention components were merged and those addressing patient safety challenges were retained to form the prototype intervention. Ethical approval was obtained for the interviews included in the trigger film, but not required for EBCD. EBCD meetings and workshops were conducted as quality improvement: people involved were collaborators, personal information was not captured, discussions were not recorded or analysed. Result(s): Co-design priorities were to support patients in: day-to-day practical medicines management;understanding the wider medicines management system;communication with healthcare teams. The three solutions were: a quick-start guide to managing multiple medicines including talking about medicines and managing new routines;tips and tricks to support day-to-day management, including planning and adherence tools;a tool supporting preparation for medication reviews and asking questions about medicines. After merging intervention components and identifying those addressing medicinesself- management patient safety challenges, five areas were retained for the prototype intervention: checking what you get;keeping on top of supplies;monitoring how you take your medicines;times when problems are more likely;and how do I know if I need help? Discussion/Conclusion: Through EBCD patients and staff worked together to improve people's experiences of managing medicines and to enhance safety. The prototype intervention addresses five areas where older people with complex medicines regimens require support. The intervention requires feasibility testing and subsequent robust evaluation. Strengths and limitations: * A variety of staff roles joined the co-design, offering multiple different perspectives on medicines management * EBCD meetings and workshops were run online to avoid Covid infections. This may have excluded older people with no access to internet.

General practitioners' views on the electronic transfer of prescriptions to pharmacies in Ireland: a qualitative interview study

Introduction: The use of electronic systems to transfer prescriptions continues to grow in healthcare systems worldwide. In response to the COVID-19 pandemic, legislation was implemented in Ireland in April 2020 to permit the electronic transfer of prescriptions (ETP) from prescribers to pharmacies using a national secure email system (Healthmail). This has resulted in a significant increase in the volume of prescriptions transmitted via Healthmail from general practitioners (GPs) to pharmacies in Ireland. Aim(s): With a clear need to evaluate how stakeholders have been affected by this initiative and to guide the future delivery of patient care, the primary aim of this study was to investigate GPs' views on the ETP to pharmacies in Ireland via Healthmail and how it has affected their practice. Method(s): Semi-structured interviews were conducted via video-conference with GPs in Ireland. GPs were identified using convenience and snowball sampling, purposively ensuring variety in age/years of experience, gender, and practice location. Interviews were audio-recorded and transcribed verbatim. Interview transcripts underwent thematic analysis (1). Result(s): Twelve audio-recorded interviews were conducted with GPs between May 2021 and July 2021. The participants had a median of 16 years' experience as a GP. Four main themes were generated: 1) Efficiencies with prescribing and easing GP workload: even with limited training, GPs felt that Healthmail's ETP has been easy to use and seamlessly integrated into their practice. Time has been saved and overall workload decreased due to less prescription printing and delegating more to administrative staff with prescription ordering. 2) New GP-pharmacist communication pathways: GPs found asynchronous communication regarding prescription queries less disruptive to their workflow, and particularly useful for less urgent matters. Some GPs were not aware of some Healthmail functions that facilitated additional notes between GPs and pharmacists, whilst others were concerned they had no evidence if pharmacists saw these notes. 3) Security, transparency, and documentation: whilst acknowledging their lack of technological expertise, GPs perceived that Healthmail prescriptions had security advantages over physical ones overall;the increased transparency of the prescription journey minimises the risk of prescriptions being mislaid, damaged, or fraudulently altered, as well as creating an audit trail. 4) Implications for patients: ETP via Healthmail has reduced footfall to practices, reduces multiple pharmacy use, and most patients have adapted well to it. GPs were mostly reluctant to engage routinely in any hypothetical bidirectional communication with patients via Healthmail. Conclusion(s): This study provides strong evidence for continuing the ETP to pharmacies in Ireland as GPs found this initiative easy to use, time-saving, and enhancing both GP-pharmacist communication and GP workflow. However, this study has highlighted stakeholders' lack of awareness with some functions of Healthmail, so any future systems utilised for the ETP should come with best-practice guidance for all users. While the purposive sampling facilitated GP heterogeneity, snowball sampling may have somewhat reduced the diversity in views;a future survey would be useful in identifying if any GPs characteristics significantly influencing GPs' views, as well as identifying other issues experienced and novel ideas to improve the ETP process going forward.

Hospital in Crisis: The Story of Mass Communication Efforts during the Covid-19 Pandemic

Purpose of study The COVID-19 pandemic led to an unprecedented rapid transmission of healthcare information. This information was critical to enact frequently changing patient care protocols and to inform staff about redistribution of hospital resources at New York University Langone Hospital- Long Island. In this investigation, we analyze our hospital clinicians' methods of mass communication to front-line health care workers, with particular interest in assessing how communication was informed by real-time clinical findings. At the height of the pandemic (March 25th- April 15th), a mass broadcast email disseminated daily from the Director of Pulmonary and Critical Care was effective in informing treatment protocols that were clinically observed to improve patient outcomes. We analyzed over thirty broadcast emails and identified three major categories of information that were routinely addressed and/or updated: (i) reallocation of resources, (ii) clinical protocol changes, (iii) recommended lab tests for monitoring patient clinical course. We also interviewed key hospital clinicians and administrators on their experience working during the height of the pandemic. We found treatment protocols in these emails included information regarding the use of steroids and monoclonal antibody therapy, ventilators, and patient repositioning. In addition, the hospital's first autopsy results on COVID related deaths gave further insight into the disease process and manner of death for many patients (diffuse alveolar damage and evidence of hypercoagulability). So, too, did clinical findings around this time support what was seen grossly on autopsy-patients with more severe disease often presented with serial d-dimer levels >6x the normal limit. The information through these different conduits was synthesized and subsequently communicated in the aforementioned mass emails as an anticoagulation treatment protocol. Through continuous input of data, this protocol was updated and adjusted over the course of three weeks. We found that real-time communication amongst hospital staff regarding patient treatment protocols was a dynamic process that required synthesis of lab values, autopsy findings, and observed response to treatments. Successful treatment of patients depended on continuous review and communication of this information. Methods used The COVID-19 pandemic led to an unprecedented rapid transmission of healthcare information. This information was critical to enact frequently changing patient care protocols and to inform staff about redistribution of hospital resources at New York University Langone Hospital-- Long Island. In this investigation, we analyze our hospital clinicians' methods of mass communication to front-line health care workers, with particular interest in assessing how communication was informed by real-time clinical findings. At the height of the pandemic (March 25th- April 15th), a mass broadcast email disseminated daily from the Director of Pulmonary and Critical Care was effective in informing treatment protocols that were clinically observed to improve patient outcomes. Summary of results We analyzed over thirty broadcast emails and identified three major categories of information that were routinely addressed and/or updated: (i) reallocation of resources, (ii) clinical protocol changes, (iii) recommended lab tests for monitoring patient clinical course. We also interviewed key hospital clinicians and administrators on their experience working during the height of the pandemic. We found treatment protocols in these emails included information regarding the use of steroids and monoclonal antibody therapy, ventilators, and patient repositioning. In addition, the hospital's first autopsy results on COVID related deaths gave further insight into the disease process and manner of death for many patients (diffuse alveolar damage and evidence of hypercoagulability). So, too, did clinical findings around this time support what was seen grossly on autopsy- patients with more severe disease often presented with seri l d-dimer levels >6x the normal limit. The information through these different conduits was synthesized and subsequently communicated in the aforementioned mass emails as an anticoagulation treatment protocol. Through continuous input of data, this protocol was updated and adjusted over the course of three weeks. Conclusions We found that real-time communication amongst hospital staff regarding patient treatment protocols was a dynamic process that required synthesis of lab values, autopsy findings, and observed response to treatments. Successful treatment of patients depended on continuous review and communication of this information.

Telemedicine Training to Improve Healthcare Access for Senior Living Community Residents in Lewistown, Montana

Purpose of Study In response to the coronavirus pandemic, the Central Montana Medical Center (CMMC) in Lewistown, Montana bolstered its telemedicine program while restricting in-person visits. Patients inexperienced with technology- -especially the elderly-forwent care. The purpose of this study was to determine how telemedicine access can be improved for residents of Lewistown senior living communities (SLCs), defined as independent, assisted living and nursing home facilities for older adults. Methods Used CMMC administration cite patient inexperience with technology and clinician buy-in as the largest barriers to telemedicine utilization (personal communication, July 28, 2020). To elucidate, Lewistown SLC administrators were surveyed. The vast majority did not assist residents with telemedicine visits, but almost all expressed interest in offering it if training were provided. CMMC clinicians were also surveyed. Most had no telemedicine training and few felt comfortable using it. Therefore, SLC staff and clinician training were identified as avenues to improve telemedicine delivery. Two studies were evaluated to ascertain the benefit of such interventions. Summary of Results The first study found access to telemedicine and telemedicine-trained staff reduced emergency department (ED) use among SLC residents by 18% annually. Residents without access to such services experienced a 1% growth in ED visits (Shah et al., 2015). The second study assessed variability in medical care between virtual visit companies. Significant variations were observed across all measures, underscoring the necessity of provider telemedicine training (Schoenfeld et al., 2017). Both studies and SLC/clinician survey results were presented to CMMC administration. Conclusions Training SLC staff to assist residents with telemedicine visits may increase telemedicine usage and healthcare access. Similarly, training CMMC clinicians on virtual physical exams and history collection may improve their confidence in telemedicine technology and quality of virtual care. The survey results and literature suggest both interventions would have a significant impact on telemedicine delivery in Lewistown. Future steps include determining level of training for SLC staff and exploring telemedicine training programs for providers.

The experience of a district general hospital when recruiting patients from across the region into a national study within a rare cancer

Introduction: Mesothelioma is a rare cancer with over 2500 cases diagnosed annually in UK. The disease is historically associated with poor survival and high symptom burden. Prior to 2022, there was only one NICE approved NHS treatment option and no agreed, long term second line therapy. Clinical trials investigating new therapies often opened in a small number of specialist centres resulting in significant travel for patients. Harrogate District General Hospital is part of the Harrogate & District NHS Foundation Trust (HDFT) and the smallest organisation within the West Yorkshire & Harrogate Cancer Alliance. Method(s): HDFT became a regional recruitment centre for CONFIRM, a double blinded, single agent immunotherapy versus placebo, clinical trial. Initially aimed at the third line setting, involving a 2:1 randomisation, HDFT enrolled patients from across the Yorkshire Region. The team included a Consultant Medical Oncologist, 2 Research Nurses, trial administrator and Regional Mesothelioma UK CNS, helping identify the trial and providing additional support to the research nurses and patients recruited. The team had to employ new strategies to manage the complexities involved. At the time, there was no consensus on alternative NHS treatment options. The window of opportunity to enter was often short making good lines of communication with referring teams essential. Co-ordination of appointments to minimise the burden of travel on this vulnerable group of patients was also vital. Result(s): CONFIRM showed improved overall survival in patients with relapsed malignant pleural and peritoneal mesothelioma [1], possibly influencing change in treatment options when NHS England announced interim drug use approvals during the COVID Pandemic [2]. HDFT recruited 18 patients (5.4% of 322 Nationally). 27 patients were referred and approached, 21 consented, 3 failing screening. Conclusion(s): CONFIRM at HDFT demonstrates that small teams can contribute to national research. References: [1] Fennell et al. (2021) [2][NHS England (2020) Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Benchmarking staffing in paediatric respiratory laboratories in Australia

Introduction/Aim: TSANZ Accreditation recommends sufficient staff to adequately meet service needs. There are no specific benchmarking FTE guidelines for both Scientific and Administrative staff. The aim of this project was to benchmark scientific and administrative staff in paediatric laboratories in Australia and NZ. Method(s): Eight paediatric laboratories from tertiary hospitals in Australia (7) and New Zealand (1) were invited to participate by providing the number and range of tests performed for years 2019, 2020, 2021. An activity study previously performed by 2 hospitals with input from a third was used to apply time weighting to each test. The hours taken for each test and Scientific FTE were analysed and results were evaluated via the program Tableau. Result(s): Two laboratories were unable to provide testing data and one laboratory had incomplete data sets making it difficult to determine FTE. Data was collated from five laboratories. Due to COVID-19 lockdowns in 2020-2021, only data from 2019 was used for benchmarking purposes. Total hours of testing per year were calculated and divided to give weekly amounts. This was then compared to the total amount of available weekly FTE hours. In 2019, scientific staff spent 26% (range 17%-36%) of their week in patient testing. During COVID-19 (2020 and 2021) the average testing time was 20% (range 14%-26% and 11%-28%). Laboratories with administrative staff spent more of their week in patient testing than those without (average: 28% vs. 23%). Conclusion(s): The raw number of tests a laboratory performs does not accurately define staffing FTE in paediatric laboratories in tertiary hospitals. Time weighting for specific tests should be considered when assessing staffing requirements. Laboratories with the most dedicated administrative FTE scientific staff were able to spend a greater portion of their week performing tests. Scientific staffs are required to undertake mandatory duties such as equipment calibration, meetings, professional development and research. Limitations to this study include differences in record keeping between laboratories. A more thorough time in motion study to include complex testing could be performed.

Aggression, mini-aggression, and abuse against health care workers during the COVID-19 pandemic

Introduction: COVID-19 pandemic brought multiple negative consequences that go beyond the direct damage caused by the disease and that affect health systems as well. Complaints of attacks against health care workers became frequent and concerning. The objective of this survey was to characterize the frequency and type of violent behavior against front-line professionals in Latin America. Material(s) and Method(s): A cross-sectional electronic survey was carried out between January 11th to February 28th, 2022. Different health care workers from Latin America who have been delivering care at least from March 2020, regardless of whether they assist or not patients with COVID- 19 were included. A non-probabilistic snowball sampling was performed, and the survey was Results: The survey was responded by 3,544 participants from 19 countries (Figure 1);58.5% were women, and the mean age was 41.9+/-11 years. The 70.8% were doctors, 16% nurses, 3.4% physiotherapists, and the remaining 9.8% had other functions within the health team. About 85.1% of physicians were specialists: 33.9% were cardiologists, 14.4% were intensivists or emergency physicians, 10.9% had some surgical specialty, 7.7% were pediatricians or related subspecialties, and the remaining 33.1% had other specialties. The 36.3% and 28.8% worked in public and private practice respectively, the remaining worked in both. Direct and regular care to COVID-19 patients was provided by 74.7% of all contestants. Among the participants, 54.8% reported acts of violence: 95.6% suffered verbal violence, 11.1% physical violence, and 19.9% other types. 39.5% of respondents experienced it at least once a week. The acts of violence involved patients' relatives (32%), or patients together with their relatives (35.1%). The victims rated the stress level of these events with an average of 8.2+/-1.8 points (scale from 1 to 10). Approximately half of the health personnel who suffered an assault experienced psychosomatic symptoms after the traumatic event (Figure 2). Among the victims of violence, 56.2% considered changing their care tasks, and 33.6% abandoning their profession. However, only 23% of the health personnel attacked stated that they had made some type of legal action regarding these acts. In a logistic regression model, doctors (OR 1.95, p<0.01), nurses (OR 1.77, p=0.001), and administrative staff (OR 3.20, p<0.01) suffered more violence than other health workers. Women more frequently suffered violence (OR 1.56, p<0.01), as well as those who worked with patients with COVID-19 (OR 3.59, p<0.01). Conversely, a lower probability of violence was observed at older ages (OR 0.96, p<0.01). Conclusion(s): We detected a high prevalence of violence against health personnel in Latin America during the current pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be more vulnerable. It is imperative to develop strategies to mitigate these acts and their repercussions on the health team. (Figure Presented) .

A Cross Sectional Study of Patient Safety Attitude among Nurses Working in Teaching Hospitals in Klang Valley, Malaysia

Nurses are one of the most important personnel that plays a major role in ensuring safe and high-quality care to the patients. Their attitudes toward patient safety could affect the patient experience in the hospital setting. Contrasting evidence in the previous study on the relationship between duration of working experience with the attitude toward patient safety warranted further exploration in the current pandemic era. The purpose of this study was to determine the perception of attitude towards patient safety and other associated factors. A cross-sectional study was conducted involving nurses from selected teaching hospitals in Klang Valley, Malaysia during the Covid-19 pandemic period. Data was collected using validated online Safety Attitude Questionnaires (SAQ). The target group was nurses in charge of general medical and surgical wards and was conveniently sampled. A total of 152 nurses participated and had working experience of more than 2 years (93.4%). The majority of positive responses were observed in 4 domains which were the teamwork climate, safety climate, job satisfaction, and stress recognition. The highest positive responses were found for the safety climate domain. In terms of negative responses, it was observed to be highest in the preparation of the unit management domain. However, there was no significant association between any domains with age group, gender, or working experience. In conclusion, the perception of the nurses toward patient safety attitude might be influenced by the managerial style, geographical work setting, and different job scopes. The leaders in a healthcare facility or service delivery should consider focusing on a strategy to ensure adequate management support for the medical personnel that might influence their attitude to patient safety culture in the future.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Implementing patient-initiated follow-up in dermatology: a local departmental experience

As part of the National Health Service's response to the COVID-19 pandemic (https://www.england.nhs.uk/outpatienttransformation- programme/patient-initiated-follow-up-givingpatients- greater-control-over-their-hospital-follow-up-care/), and in line with the personalized care agenda (https://www.bad. org.uk/shared/get-file.ashx?itemtype=document&id=7237), 'patient-initiated follow-up' (PIFU) is being implemented across secondary care. This has been introduced by the National Outpatients Transformation Team and the aim of this initiative is to encourage self-management in patients and facilitate shared decision-making, together with supporting clinical waiting list reviews. The expected benefits include flexible personalized pathways and better access to specialist care when needed, thus benefiting general practitioners and the department. It replaces the old-style 'open appointment', which was rigid, without a clear pathway and not accurately recorded, impacting on demand and capacity planning. The British Association of Dermatologists has adapted this guidance and produced a document to support the roll out of this initiative throughout dermatology departments in England.4 It is important that clinicians appropriately assess which patients are suitable for PIFU. Criteria for selection include a low risk of urgent follow-up;confident to take responsibility of their care by understanding the condition, symptoms and when to seek advice;and understanding how to re-access care. Our experiences in setting up and using the PIFU pathway are shared. In our trust, it was first rolled out in dermatology and urology, two specialities with a high number of follow-ups. For dermatology, we included clinics in the main department and across all four community sites. In order to set up this service, engagement was sought with key stakeholders (service managers, administrative teams and clinicians). A Standard Operating Procedure was created to classify the pathway, agreed processes for the administrative and secretarial team, and written information for patients and general practitioners. Education sessions were given on how to use PIFU, assess patient suitability and measure outcomes. From September 2021 to November 2021, 548 patients have been added onto a PIFU and, as of December 2021, 11 have used it to re-access care. A staff survey has been done and has shown overall positive feedback, with 68% having a positive experience and only 8% having a negative experience. Seventy-six per cent of staff feel it is better for patients and doctors/administrators, and 95% would recommend it to other departments. The only negative issues have been an increase in workload for the secretaries who send out the written information. We aim to obtain patient feedback once more have re-accessed care, which we hope to present alongside our experiences on the benefits and challenges of implementing PIFU.

Improving Data Quality in Multicenter Trials: Innovative Approaches Utilized within the Wake Forest Nci Community Oncology Research Program Research Base (Wf Ncorp Rb)

Introduction: Efficient and comprehensive trial oversight and data management ensures valid, robust outcomes necessary to inform health policy and improve patient outcomes. This is particularly challenging in the context of multicenter trials. The format of this session will include four introductory presentations (15 min each), followed by 30-min panel discussion/Q&A focusing on recent experiences and innovative approaches utilized within the Wake Forest NCI Community Oncology Research Program Research Base (WF NCORP RB). Since 2017, WF has managed 15 studies with approximately 3000 patient and 1000 provider/stakeholder accruals across 1000 potential participating community oncology practices within the United States and Puerto Rico. These practices often operate differently from academic medical centers, with varying patient capacity, provider number and level of engagement, use of advanced practice providers, and services offered. In addition, practices within this network have heterogeneous utility of electronic health records (EHRs) and display a wide range of clinical research staffing models. The COVID-19 pandemic has highlighted the need for streamlining research visits and maximizing telehealth technologies when applicable, particularly for intervention non-therapeutic clinical trials. As such, research expectations must be standardized to ensure quality trial conduct and data collection across diverse practices. Recently, the WF NCORP RB has taken many steps to improve efficiency and data quality across our studies. This session will discuss a comprehensive approach to data quality and management across the lifespan of a trial. This starts with consent/ recruitment strategies and general oversight/ monitoring of our portfolio of trials. WF RB now utilizes REDCap for all data capture, as this allows direct data entry for site personnel and participant entered patient-reported outcomes using surveys. In addition, REDCap facilitates data monitoring, query, and auditing strategies. We will also introduce a team-based approach to adjudicate complex outcomes. Talk 1 (15 min): Specifically, Karen Craver, our RB administrator, will discuss approaches to obtain robust data as a result of strong screening and recruitment. She will provide an overview on how we survey practice research staff within the Landscape assessment and brief, pre-trial interest surveys to identify optimal target populations during the planning stage. We utilize our internal EHR to create custom screening reports to identify potential participants and generalize these for other practices to customize and use as a screening tool within their clinic. The RB has integrated remote consenting in part due to the pandemic, but we realize the need to continue offering flexibility in consent modality moving forward. Talk 2 (15 min): Emily Dressler, lead Biostatistician, will discuss oversight of the RB portfolio using dynamic reports within Tableau. These reports update daily and provide a comprehensive assessment of all ongoing and completed studies. RB personnel can filter reports to create custom results subset by timeframe, practice or set of practices, trial type, and/or other demographic characteristics. This has greatly reduced the request for study-specific accrual reports and has standardized our reporting across studies. She will also discuss the rationale for transitioning to REDCap, including strengths and weaknesses for integrating in multicenter studies. Talk 3 (15 min): Bill Stanfield, lead data manager, will demonstrate our utilization of the REDCap Data Resolution Workflow and Data Quality modules to efficiently manage data collection, data quality, and audits. He will show how REDCap can be used to seamlessly communicate with research staff to obtain missing or late data, verify out of range values, and then validate and lock responses for analysis. Talk 4 (15 min): Glenn Lesser, WF NCORP multiple principal investigator (mPI), will discuss a team approach to adjudicating cancer treatment information that often consists of combination of surgery, radiation, chemotherapy, or immunotherapy/targeted agents. This remains a particularly challenging problem in large trials enrolling patients with multiple types of cancer who may be treated with a wide spectrum of standard therapeutic regimens. This diversity limits both the effectiveness of automated reviews of remote data entries and the study-specific training of data management staff at sites. Data are pulled in real time from multiple forms within REDCap and collated into participant-level summaries of treatment, starting with the time of baseline assessment and sorted sequentially for each drug administration or event. A multidisciplinary team of data managers, biostatisticians, and clinicians meet to adjudicate each participant as data collection completes. Particularly for trials with multiple cancer types or treatment regimens, our experience with this approach has shown it identifies significant data gaps in treatment, with at least 75% of entries requiring clarification from research staff prior to finalizing and locking data. This process highlighted the challenge of real-time adjudication of treatment data in patients receiving multiple anti-cancer agents, given at varying doses and schedules, and in multiple combinations and/or phases over an individual patient's course of therapy. Panel (30 min): We will conclude with a panel discussion and Q&A. The panel will contribute additional perspective on implications of these strategies in the conduct of multilevel cancer care delivery research studies. We will also incorporate perspectives from NCORP community sites implementing these strategies. Panelists will discuss the broad applicability of these strategies for diverse trials, with attention to size/ complexity, database vendor, and patient population.

Hand care: it's time to take the gloves off

The increased incidence of hand dermatitis (HD) is well documented in healthcare professionals (HCPs) (Flyvholm MA, Bach B, Rose M, Jepsen KF. Self-reported hand eczema in a hospital population. Contact Dermatitis 2007;57: 110-15). It is reported that HD accounts for 95% of all occupational dermatitis (Bains SN, Nash P, Fonacier L. Irritant contact dermatitis. Clinic Rev Allergy Immunol 2019;56: 99-109). We sought to better understand the prevalence of HD in HCPs in a large teaching hospital, identify any associated risk factors and assess their knowledge of hand care. Additionally, we aimed to assess the availability of ward facilities and posters for hand hygiene and hand care. The survey was conducted between November 2015 and January 2016. A review of ward facilities and posters for hand care and hand hygiene was conducted in October 2020. A total of 820 HCPs responded to the survey. Altogether, 444 respondents (54 1%) reported a previous history of HD and 226 (27 6%) reported active dermatitis. These included 153 (18 6%) doctors/ dentists, 76 (9 3%) allied health professionals (AHPs), 46 (5 6%) nurses/midwives, 27 (3 3%) administrative staff, 16 (1 9%) other, five (0 6%) technicians and 108 (13 2%) medical/ dental/nursing/midwifery/AHP students. Only 10 (1 2%) took time off work owing to their HD, with five (0 6%) requiring > 5 days off work, but 67 (8 2%) wished they had taken time off work. In total, 416 (50 7%) respondents washed their hands > 20 times daily and 229 (27 9%) used disinfectants > 20 times per day. Those with a prior history of atopic dermatitis (AD) were at higher risk of developing HD [relative risk (RR) 1 69, 95% confidence interval (CI) 1 52-1 89;P < 0 001], and within 6 months of starting their job/placement (RR 1 82, 95% CI 1 3-2 5;P < 0 002). Only 107 (13 0%) respondents were able to identify all 11 correct statements regarding hand care. Two hundred and twenty (49 5%) of the 444 HCPs with a history of HD never received hand care advice when they started their current role. The 24 adult wards surveyed had a total of 162 general-use sinks, all with hand soap and disinfectant, and 154 hand hygiene posters. In contrast, only 22 sinks had emollients available. No posters were seen regarding hand care and skin health. This survey highlights the high prevalence of HD among HCPs, especially those with AD, but many are still not aware of good hand care measures. Additionally, our survey reflects the need for early education and equal facilities for hand care and hand hygiene, as both are important when delivering good clinical care, to protect patients and staff, especially in the midst of the COVID-19 pandemic.

Changing English Local Authority Duties by the Adoption of Easements in the COVID-19 Pandemic, Findings from an Interview-Based Study

This article reports findings from a study on the effect of the adjustments or 'easements' that were made to the 2014 Care Act when measures to manage the impact of COVID-19 were introduced in England in 2020. Only eight local authorities (LAs) implemented the changes permitted. The experiences of five are explored in this article. Data were collected in 2021 through interviews with Directors of Adult Social Services and other senior managers in these LAs and analysed using a thematic approach. Participants referred to the challenges under which they were working pre-pandemic, including resource pressures and problems recruiting and retaining staff. Despite the conditions attached to adopting easements these LAs had done so because of the uncertainties they were facing. All ceased to use them within a short time because they could manage without them. They had been shocked by the concerted opposition to easements and the time necessitated in responding to this. They contrasted their experiences with the apparent ease with which NHS colleagues had been able to change their practices. The experiences of these LAs may contribute to planning for the continuity of social care in any future emergency.

Prevalence and Severity of COVID-19 and Missed Job Opportunities among Healthcare Workers in Mazandaran Province, February-June 2020.

Background and purpose: The COVID-19 pandemic resulted in an uncontrolled disease burden on healthcare workers (HCWs) worldwide. We aimed to investigate the prevalence and severity of COVID-19 in HCWs of selected hospitals in Mazandaran province and examine the association between COVID-19 and missed opportunities of HCWs. Material(s) and Method(s): In this retrospective descriptive-analytical study, 1105 HCWs in Qaemshahr Razi Hospital and Sari Fatemeh-Zahra Hospital were studied between February 2020 and June 2020. In order to evaluate the frequency and severity of the disease, clinical and paraclinical manifestations were recorded by a trained HCW. Data were analyzed in SPSS V18. Result(s): The frequency of COVID-19 was 16.19% among HCWs. The patients included 113 (63.13%) nurses, 47(26.26%) service providers and administrative personnel, and 19(10.61%) physicians. Duration of sick leave was found to be significantly associated with severity of COVID-19 (P=0.006). This length was also significantly associated with the job and was longer in nurses (P=0.013). Our findings revealed a significant relationship between the level of adherence to personal protective equipment (PPE) and the severity of COVID-19 (P=0.001). Conclusion(s): COVID-19 could exert remarkable impact on the quality of work in HCWs, especially among nurses. Effective training of HCWs regarding PPE instructions results in suitable protection against severe forms of the disease.Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.

What's up in Whatsapp - Telecytopathology Experience Connecting Rural Districts of Punjab to a Tertiary Care Center in India

Introduction: The telemedicine center of our hospital provides expert consultation services to two rural districts of Punjab. The aim of this study was to assess its utility in Fine needle aspiration Cytology (FNAC) diagnostic service. Material(s) and Method(s): A 2-year retrospective audit from April 2020-2022 covering the COVID pandemic time was carried out on all cases of telecytopathology consultation files of the E-sanjeevani platform. A total of 75 cases whose FNAC smear images clicked by android smartphones with 48MP cameras and sent by Whatsapp to the E-Sanjeevani administrator were included. The images along with brief case clinical details were e-mailed for expert opinion to the cytopathologist (RS). The image quality, ability to provide a diagnosis, site-wise differences and comparison of the referral and expert review diagnosis was made. Result(s): The ages of the patients ranged from 4-80 years (2 children, 73 adults), with 25 males and 50 females. The sites of FNA performed at the district hospital were lymph nodes (22), breast (21), thyroid (15), soft tissue (8), salivary gland (2), skin (4), lip (2) and glans penis (1). The number of Whatsapp images evaluated ranged from 3-20 with median of 11 per case. They were in JPEG file format with size ranging from 40-163kb. Image quality was rated visually as good, medium, and poor in 46 (61%), 21m (28%) and 8(11%) cases respectively. There was no distortion of images upon enlarging them for better visualization on a large monitor. Best accuracy was obtained in breast and lymph nodes FNA. Soft tissue FNA was difficult to interpret and was inconclusive in 3/8 cases. Conclusion(s): Telecytopathology by Whatsapp is simple, quick, feasible and very useful to provide expert opinion in FNAC of various sites thereby enabling the pathologist in the district hospital setting. (Figure Presented).